Evaluation and selection of therapy for divergent dislocation of elbow in children

Objective To explore the clinical characteristics, treatments and outcomes of divergent dislocation of elbow in children. Methods From February 2013 to February 2017, 11 children with divergent dislocation of elbow were treated. There were 9 boys and 2 girls with an age at the time of injury of 5-13 years. The involved side was left (n=8) and right (n=3). Concomitant injuries included distal metaphyseal radius fracture (n=1), avulsion fracture of coronoid (n=5) and olecranon fracture (n=2). They presented at 2 to 24 hours after injury. Closed reduction of divergent dislocation was performed under general anesthesia. After successful closed reduction, elbow was placed in a long arm cast. If closed reduction failed, open reduction was performed. Results Successful closed reduction of divergent dislocation was achieved in 10 cases and 1 failed due to an interposition of annular ligament during open reduction. Open reduction and internal fixation of Kirschner’s wire were performed for displaced olecranon fracture in 2 cases. And one case of distal metaphyseal radius fracture underwent pertacuneous reduction and fixation. The average follow-up period was 13 months. Follow-up radiographs showed stable elbow. There was no onset of recurrence, avascular necrosis of distal humerus or physeal arrest. All cases regained full strength free of symptoms. There was nearly a full range of motion except for 1 case of heterotopic ossification of elbow (flexing of elbow at 100°~40°~0°). Conclusions Divergent dislocation of elbow is rare and complex in children. Closed reduction may be easily achieved in most cases. If closed reduction fails, open reduction should be performed. Most cases of divergent dislocations of elbow may obtain an excellent functional outcome. Key words: Elbow joint; Dislocations; Child